Abstract: We conducted a systematic review of video communication in home care to provide insight into the ratio between the costs and financial benefits (i.e. cost savings). Four databases (PUBMED, EMBASE, COCHRANE LIBRARY, CINAHL) were searched for studies on video communication for patients living at home (up to December 2009). Studies were only included when data about the costs of video communication as well as the financial benefits were presented. The methodological quality of the included studies was assessed. Nine studies, mainly conducted in the US, met the inclusion criteria. The methodological quality was poor, except for one study. Most studies (8 of the 9) did not demonstrate that the financial benefits were significantly greater than the costs of video communication. One study - the only one with a high methodological quality - found that costs for patients who received video communication were higher than for patients who received traditional care. The review found no evidence that the cost of implementing video communication in home care was lower than the resulting financial benefits. More methodologically well conducted research is needed.
Abstract: The purpose of this study was to determine the extent to which patients discharged "home to self care" experienced problems and unmet needs. A secondary aim was to explore potential differences in problems and unmet needs between medical and surgical patients.
Abstract: Many devices are in use to prevent pressure ulcers, but from most little is known about their effects and costs. One such preventive device is the Australian Medical Sheepskin that has been proven effective in three randomized trials. In this study the costs and savings from the use of the Australian Medical Sheepskin were investigated from the perspective of a nursing home.
Abstract: Intertrigo in the large skin folds is a common problem. There is a plethora of treatments, but a lack of evidence about their efficacy. A nursing guideline on this matter had to be updated and broadened in scope to other health care professionals.
Abstract: A multicenter prospective randomized clinical trial was undertaken to investigate the effectiveness of the Australian Medical Sheepskin (AMS) in the prevention of sacral pressure ulcers in somatic nursing home patients. Patients were randomized at admission and were then followed daily for 30 days. The experimental group received usual care plus an AMS as a layer on the mattress within ultimately 48 hours after admission; the control group received usual care only. Usual care was all the care that nursing wards normally applied for pressure ulcer prevention without any further standardization for this study. A total of 588 patients were randomized (293 control and 295 experimental group) and the data of 543 patients could be analyzed (272 from the control and 271 from the experimental group). The incidence of sacral pressure ulcers grade 1 or higher was significantly lower in the experimental group than in the control group (8.9% vs. 14.7%). In a multilevel analysis on the incidence of pressure ulcers adjusted for Braden risk score, age, and gender, it shows an odds ratio of 0.53 (95% confidence interval: 0.29-0.95), meaning a significant protective effect of the AMS. These results are in line with the results of two earlier trials on the AMS in hospital patients. The majority of patients in our trial that used an AMS rated it positively, but one-third found the sheepskin too warm. We conclude that the AMS is an effective aid in the prevention of sacral pressure ulcers in nursing home patients.
Abstract: To assess the effectiveness of the Australian Medical Sheepskin in preventing sacral pressure ulcers (PUs), based on combined data from existing published trials.
Abstract: The objective of this study was to identify and to assess the quality of evidence-based guidelines and systematic reviews we used in the case of oral mucositis, to apply general quality criteria for the prevention and treatment of oral mucositis in patients receiving chemotherapy, radiotherapy or both.
Abstract: BACKGROUND: Pressure ulcers are a major problem, especially in nursing home patients, although they are regarded as preventable and there are many pressure relieving methods and materials. One such pressure relieving material is the recently developed Australian Medical Sheepskin, which has been shown in two randomized controlled trials 12 to be an effective intervention in the prevention of sacral pressure ulcers in hospital patients. However, the use of sheepskins has been debated and in general discouraged by most pressure ulcer working groups and pressure ulcer guidelines, but these debates were based on old forms of sheepskins. Furthermore, nothing is yet known about the (cost-)effectiveness of the Australian Medical sheepskin in nursing home patients. The objective of this study is to assess the effects and costs of the use of the Australian Medical Sheepskin combined with usual care with regard to the prevention of sacral pressure ulcers in somatic nursing home patients, versus usual care only. METHODS/DESIGN: In a multi-centre randomised controlled trial 750 patients admitted for a primarily somatic reason to one of the five participating nursing homes, and not having pressure ulcers on the sacrum at admission, will be randomized to either usual care only or usual care plus the use of the Australian Medical Sheepskin as an overlay on the mattress. Outcome measures are: incidence of sacral pressure ulcers in the first month after admission; sacrum pressure ulcer free days; costs; patient comfort; and ease of use. The skin of all the patients will be observed once a day from admission on for 30 days. Patient characteristics and pressure risk scores are assessed at admission and at day 30 after it. Additional to the empirical phase, systematic reviews will be performed in order to obtain data for economic weighting and modelling. The protocol is registered in the Controlled Trial Register as ISRCTN17553857.
Abstract: Nowadays more and more clinical guidelines for health care professionals are being developed. However, this does not automatically mean that these guidelines are actually implemented. The aim of this meta-review is twofold: firstly, to gain a better understanding of which factors affect the implementation of guidelines, and secondly, to provide insight into the "state-of-the-art" regarding research within this field.
Abstract: Many patients encounter a variety of problems after discharge from hospital and many discharge (planning and support) interventions have been developed and studied. These primary studies have already been synthesized in several literature reviews with conflicting conclusions. We therefore set out a systematic review of the reviews examining discharge interventions. The objective was to synthesize the evidence presented in literature on the effectiveness of interventions aimed to reduce post-discharge problems in adults discharged home from an acute general care hospital.
Abstract: It is known that many patients encounter a variety of problems in the first weeks after they have been discharged from hospital to home. In recent years many projects have addressed discharge planning, with the aim of reducing problems after discharge. Telephone follow-up (TFU) is seen as a good means of exchanging information, providing health education and advice, managing symptoms, recognising complications early, giving reassurance and providing quality aftercare service. Some research has shown that telephone follow-up is feasible, and that patients appreciate such calls. However, at present it is not clear whether TFU is also effective in reducing postdischarge problems.
Abstract: In this paper, Patriek Mistiaen, Else Poot, Sophie Hickox, and Cordula Wagner describe how they conducted a search of the Cochrane Database of Systematic Reviews in order to explore the evidence for nursing interventions. They identify the number of studies, the number of participants, and the conclusions of systematic reviews concerning nursing interventions. They conclude that the Cochrane Database of Systematic Reviews is a valuable source of evidence about nursing interventions, and can be used as a means of developing a research agenda in the case of inconclusive reviews.
Abstract: Intertrigo is an inflammatory dermatosis of the skin folds of the body, for which a large variety of topical medications may be recommended. A systematic literature review was performed to find scientific evidence for preventing and treating intertrigo within the nursing domain. Seven electronic databases were searched with a simple broad-scope search strategy. The aim was to identify all publications that concerned intertrigo itself and other conditions that were related to intertriginous regions. This search produced 451 references. A final set of 24 studies was retained and analyzed on content and methodologic quality. Most studies concerned treatments with antifungals or disinfectants in heterogeneous research samples, with only small subsamples of people with intertrigo. Six studies were randomized controlled trials. In general, the methodologic quality of the studies was poor. The analyzed studies provided no scientific evidence for any type of nursing prevention or treatment strategy. There is a great need for well-designed clinical studies on intertrigo.
Abstract: A literature search completed over the period of 1980-1999 identified studies on the prevalence of thirst in hemodialysis (HD) patients and the relationship between thirst and interdialytic weight gain, as well as intervention studies in which thirst was used as an outcome variable. Twenty-three studies fulfilled the selection criteria and were included in the analysis. The prevalence of thirst varied between 6% and 95% across studies. In most studies more thirst was related to more weight gain. However, the studies were difficult to compare due to methodological differences. Three types of interventions were found: technical interventions in the dialysis mechanisms (increasing the frequency of dialysis sessions and varying the concentration of sodium in the dialysate), pharmaceutical interventions (ACE-inhibitors), and a dietetic intervention. Almost no conclusions could be drawn with regard to the effectiveness of these interventions due to methodological differences and weaknesses and due to the small sample sizes.
Abstract: Patients often experience problems after discharge, for instance with housekeeping or a general lack of information. The effect of a nurse-initiated Telephone Reassurance Programme (TRP) on ophthalmic patient outcomes was investigated. Patients in the intervention group were phoned by a nurse 3-6 days after being randomized and discharged home. Patients in both intervention and control groups received a questionnaire 1 week and 1 month after discharge to assess the patient outcomes 'Informational needs', 'Uncertainty', 'Emotional complaints' and 'Functional limitations'. In an attempt to explain the lack of statistically significant results, the limitations related to the participants, intervention and outcomes are discussed.
Abstract: Discharge planning is a nursing intervention that aims to ensure continuity of care; it consists of several steps of which selecting patients in need of it is the first one. The Blaylock Risk Assessment Screening Score (BRASS) index is a risk screening instrument which can be used early after admission to identify those patients in need of discharge planning.
Abstract: 1. Ophthalmic patients experience problems after discharge. For instance, most patients reported that they felt insufficiently informed, and some wanted additional help with housekeeping. 2. The most important informational needs are related to the expected recovery time and what the normal recovery signs are. Concerning housekeeping, patients experience most problems with household tasks involving heavy lifting and with shopping. 3. Nurses should address these problems and adapt their practices. For instance, nurses can mail a leaflet containing relevant information to patients before admission, or can institute a post-discharge telephone program to resolve problems.
Abstract: After discharge from the hospital, patients with cancer can have several problems at home. In this project, patients with cancer, who at time of discharge from the hospital were not indicated for nursing care at home, were offered three home visits by a community nurse. A prospective, descriptive study was undertaken to assess indicators of usefulness of these "continuity visits." It was registered how many and what patients [sex, age, (time of) diagnosis, social support, therapy] wanted to receive the visit. Care needs, as mentioned by the patients during the continuity visits, were reported after the visit by the community nurse. Both patients and community nurses completed an evaluation form after the first visit. A continuity visit was offered to 337 patients; 112 patients received a first, 50 a second, and 24 a third continuity visit. Older patients, patients without social support, and those diagnosed less than half a year before more often agreed to received a first visit. Reasons for patients not receiving a second or third visit were either that patients did not want one or on the contrary they were in need of immediate nursing care or had died before the visit. Two weeks after discharge, 93% of the patients experienced one or more physical, psychological, or social problems; 70% mentioned a need for information; and 47% needed emotional support. Both patients and community nurses evaluate the first visit positively. The findings suggest that continuation of the offer of the first continuity visit could be useful.
Abstract: The problems of elderly people following discharge from hospital is a worldwide focus of nursing attention. Actual and local insight into the nature and extent of post-discharge problems is needed as a base for improving and evaluating discharge planning. Problems following discharge were investigated as the first part of a larger study. Over a 3-month period, 251 elderly people who had been discharged after a hospital stay of more than 3 days, were asked to participate in the study. Half received a postal questionnaire and half were interviewed at home, one week after discharge. There were 145 respondents. The need for information was mentioned by 80% of the patients. Housekeeping tasks also caused most patients some difficulty. Almost 40% of those discharged reported some kind of unmet need.
